Serologic study of the prevalence of rickettsiosis in Yucatan: Evidence for a prevalent spotted fever group rickettsiosis

Because of the discovery of a spotted fever group rickettsiosis with signs and symptoms similar to dengue fever in Yucatan, Mexico, immunofluorescence assay (IFA) serology was performed on sera from 390 persons selected from a representative geographic distribution of rural Yucatan to detect antibodies reactive with Rickettsia rickettsii, R. akari, a Thai strain (TT-118) that is most closely related to a rickettsia identified in Amblyomma cajennense ticks in southern Texas, and R. typhi. The IFA antibodies at titers ≥1:64 against R. akari were detected in 22 (5.6%) of the samples with the expected cross-reactivity against the other antigens of the spotted fever group. Immunoblotting with antigens of R. akari identified antibodies against antigens of spotted fever group lipopolysaccharides and not against rickettsial outer membrane proteins A and B, which contain the species-specific epitopes. A rickettsiosis most likely caused by a relative of R. akari appears to be both prevalent and widely distributed geographically in Yucatan.